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Diabetes / Insulin sensitivity
Replies
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Hmm, considering drs believe the major contributing factors to insulin resistance for most people are inactivity and being overweight, I am not really sure about these "judgements" being ignorant.
http://www.niddk.nih.gov/health-information/health-topics/Diabetes/insulin-resistance-prediabetes/Pages/index.aspx#causes
Tell that to my Type 2 grandfather, who was skinny as a rail at diagnosis and until he died - and who always exercised. Tell that to my mother, who was not skinny at diagnosis, is normal weight now, and has always swum for an hour at least 3x a week (pre and post diagnosis) - who eats the ADA recommended diet, who takes more medication that I do, and and whose A1c is 26% higher than mine. My mother believed the ignorant judgment - and on the strength of it lost well more than 10% of her body weight - the amount she was promised would make a difference. It made none at all. (In contrast, I control my diabetes by eating low enough carbs to avoid triggering an elevated BG response. My BG was in the normal ranges 3 days after diagnosis while I was still obese. I am moving toward a normal weight - but after losing 23% of my body weight my carohydrate tolerance remains unchanged - it is, and has been, around 20 grams in a 3 hour period both at 197.3 (diagnosis) 152.2 (currently).)
There are many T2 diabetics for whom there is a correlation between weight and disease expression. I am not one of them - nor is anyone in my family (all descendants my age or older of my maternal grandfather) - nor is anyone in my spouse's family - with a similar strain of diabetes that does not correlate well (or at all) with weight.
As the spouse of a normal weight person who was a good little patient and went to the medical professionals, where she was told (1) lose weight and (2) if that doesn't help we'll just have to medicate the crap out of you - it IS an ignorant judgment when it is spewed out without an individual determination that in this person, diabetes is connected to weight.
Not to mention that it is a barrier to attaining normal BG levels when(1) all T2 diabetics are treated identically and (2) the medical profession continues to recommend solutions (weight loss & 30-50 carbs/meal) that rarely achieve better than diabetes-normal control. I'm looking for the statistics, but I believe it was feewer than half achieve what the ADA calls "tight" control - which permits BG readings of up to 130 before meals (normal would be below 100), and up to 180 2 hours after a meal (normal rarely goes above 140 - and a 180 2 hours after eating strongly suggests a spike well above 180 at around 1 hour). This is particularly troubling, given the latest study that links elevated blood glucose (even at the high normal range) with all cancers other than liver.
Just because it is a doctor (or other medical professional) passing judgment it doesn't keep it from being ignorant.
(FWIW, even AFTER that determination, it is still not clear which (if either) caused the other - or if yet a third thing caused both.)
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@neohdiver Good point about what doctors consider tight control. What the medical profession would consider "tight BG control" I consider to be unacceptably high. Normal should be the same for those with IR and without.0
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I would like to discuss, aside from the risk factors listed, how much of an influence can diet independently exert?
Suppose a normal weight active person (for example, a male expending around 3,000 calories a day) eats a diet of 55% carbs, 15% protein, 30% fat. Carb sources would include ample amounts of grains, fruits, potatoes, sugary desserts, some non-starchy vegetables, and small amounts from other sources. Now suppose this person eats 3 meals a day, and around 1,000 calories for each meal. Assuming similar macros per meal, that would translate to about 135g of carbs at each meal. Now, that's going to require a tremendous surge of insulin to help lower blood sugar from a carb load that high. Also, suppose this person eats this way day after day, year after year.
Is it not unrealistic that eventually, some of the pancreatic cells may start to wear out from having to produce so much insulin? Not to mention, depending on the exercise routine, I would think the possibility exists that the muscles may not be able to soak up as much glucose as would be required. Even with weight maintenance, it would seem to me that the latter scenario could directly lead to insulin resistance.
Also, while I do realize that there are some cultures that eat a diet high in carbs and have low rates of diabetes, my understanding is that their main carb sources are more so fruits and vegetables. In other words, in those situations the diet is more so comprised of low GI carbs (as compared to the Western world in which high GI carbs dominate).1 -
ForecasterJason wrote: »I would like to discuss, aside from the risk factors listed, how much of an influence can diet independently exert?
Suppose a normal weight active person (for example, a male expending around 3,000 calories a day) eats a diet of 55% carbs, 15% protein, 30% fat. Carb sources would include ample amounts of grains, fruits, potatoes, sugary desserts, some non-starchy vegetables, and small amounts from other sources. Now suppose this person eats 3 meals a day, and around 1,000 calories for each meal. Assuming similar macros per meal, that would translate to about 135g of carbs at each meal. Now, that's going to require a tremendous surge of insulin to help lower blood sugar from a carb load that high. Also, suppose this person eats this way day after day, year after year.
Is it not unrealistic that eventually, some of the pancreatic cells may start to wear out from having to produce so much insulin? Not to mention, depending on the exercise routine, I would think the possibility exists that the muscles may not be able to soak up as much glucose as would be required. Even with weight maintenance, it would seem to me that the latter scenario could directly lead to insulin resistance.
Also, while I do realize that there are some cultures that eat a diet high in carbs and have low rates of diabetes, my understanding is that their main carb sources are more so fruits and vegetables. In other words, in those situations the diet is more so comprised of low GI carbs (as compared to the Western world in which high GI carbs dominate).
If one is active, the amount of insulin the pancreas has to push normally wouldn't be high - the person is liable to be very insulin sensitive, so the pancreas probably isn't working that hard.
And the pancreas refusing to put out insulin would be more in line with Type 1 Diabetes. Type 2 diabetes is about the muscle, liver, and to a smaller extent adipose cells becoming insulin resistant.0 -
Maybe it's fair to say that with other environmental factors (such as a slight lack of sleep, or a bit of elevated stress), insulin resistance could slowly start in the scenario I gave. I just find it hard to believe that over the long term the pancreas would still function flawlessly with a constant overload of carbs (particularly with a decent number of high GI ones). I think it would be cool though to see a future study on insulin function for people in this situation, at least 5-15 years apart.ForecasterJason wrote: »I would like to discuss, aside from the risk factors listed, how much of an influence can diet independently exert?
Suppose a normal weight active person (for example, a male expending around 3,000 calories a day) eats a diet of 55% carbs, 15% protein, 30% fat. Carb sources would include ample amounts of grains, fruits, potatoes, sugary desserts, some non-starchy vegetables, and small amounts from other sources. Now suppose this person eats 3 meals a day, and around 1,000 calories for each meal. Assuming similar macros per meal, that would translate to about 135g of carbs at each meal. Now, that's going to require a tremendous surge of insulin to help lower blood sugar from a carb load that high. Also, suppose this person eats this way day after day, year after year.
Is it not unrealistic that eventually, some of the pancreatic cells may start to wear out from having to produce so much insulin? Not to mention, depending on the exercise routine, I would think the possibility exists that the muscles may not be able to soak up as much glucose as would be required. Even with weight maintenance, it would seem to me that the latter scenario could directly lead to insulin resistance.
Also, while I do realize that there are some cultures that eat a diet high in carbs and have low rates of diabetes, my understanding is that their main carb sources are more so fruits and vegetables. In other words, in those situations the diet is more so comprised of low GI carbs (as compared to the Western world in which high GI carbs dominate).
If one is active, the amount of insulin the pancreas has to push normally wouldn't be high - the person is liable to be very insulin sensitive, so the pancreas probably isn't working that hard.
And the pancreas refusing to put out insulin would be more in line with Type 1 Diabetes. Type 2 diabetes is about the muscle, liver, and to a smaller extent adipose cells becoming insulin resistant.
Also, I see some sources that seem to indicate that in T2D insulin secretion is impaired.
http://www.ncbi.nlm.nih.gov/pubmed/18640585
http://diabetes.diabetesjournals.org/content/50/suppl_1/S169.full.pdf
http://bmcbiol.biomedcentral.com/articles/10.1186/s12915-015-0140-6
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T2D increases with the obesity rate of a society. Sure, some people are outliers (or take drugs or engage in other behaviors that may be independently risk factors -- high soda consumption may be), but the T2D rate in traditional societies with low diabetes rates is quite low to non-existent, even with higher carb consumption (the diet as a whole is typically quite different than the average US diet, but not so much carb %). Also, people are much more active.0
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lemurcat12 wrote: »T2D increases with the obesity rate of a society. Sure, some people are outliers (or take drugs or engage in other behaviors that may be independently risk factors -- high soda consumption may be), but the T2D rate in traditional societies with low diabetes rates is quite low to non-existent, even with higher carb consumption (the diet as a whole is typically quite different than the average US diet, but not so much carb %). Also, people are much more active.
I think a large part of it is the types of carbs eaten. It appears societies that start eating grains and sugars tend to have higher rates of T2D than those that eat carbs made up of veggies and some fruits.
For example, China typically has a higher carb diet. That seemed to work well for them in the past when foods were more traditional, but now that theri diet is more westernized (more wheat and sugar than before being likely culprits) their rate of T2D is quite high. I think they are at 11%. That's higher than the USA.1 -
lemurcat12 wrote: »T2D increases with the obesity rate of a society. Sure, some people are outliers (or take drugs or engage in other behaviors that may be independently risk factors -- high soda consumption may be), but the T2D rate in traditional societies with low diabetes rates is quite low to non-existent, even with higher carb consumption (the diet as a whole is typically quite different than the average US diet, but not so much carb %). Also, people are much more active.
I think a large part of it is the types of carbs eaten. It appears societies that start eating grains and sugars tend to have higher rates of T2D than those that eat carbs made up of veggies and some fruits.
For example, China typically has a higher carb diet. That seemed to work well for them in the past when foods were more traditional, but now that theri diet is more westernized (more wheat and sugar than before being likely culprits) their rate of T2D is quite high. I think they are at 11%. That's higher than the USA.
Because introduction of diet is the only western import that ever happens in these scenarios. Sedentary time never goes up for these people.
Your best bet would be look up whatever study Eades quotes to claim Aborigines are more sedentary in the Bush than in cities and their traditional diet supposedly fixes T2D.0 -
lemurcat12 wrote: »T2D increases with the obesity rate of a society. Sure, some people are outliers (or take drugs or engage in other behaviors that may be independently risk factors -- high soda consumption may be), but the T2D rate in traditional societies with low diabetes rates is quite low to non-existent, even with higher carb consumption (the diet as a whole is typically quite different than the average US diet, but not so much carb %). Also, people are much more active.
I think a large part of it is the types of carbs eaten. It appears societies that start eating grains and sugars tend to have higher rates of T2D than those that eat carbs made up of veggies and some fruits.
For example, China typically has a higher carb diet. That seemed to work well for them in the past when foods were more traditional, but now that theri diet is more westernized (more wheat and sugar than before being likely culprits) their rate of T2D is quite high. I think they are at 11%. That's higher than the USA.
Because introduction of diet is the only western import that ever happens in these scenarios. Sedentary time never goes up for these people.
Your best bet would be look up whatever study Eades quotes to claim Aborigines are more sedentary in the Bush than in cities and their traditional diet supposedly fixes T2D.
You are saying the Chinese may be more sedentary now than in the past, or that they are more sedentray than Americans are?
Sure. They might be.
Obesity rates in China are somewhere between 5 and 20%, with 20% being in urban areas. Obesity in the USA is what? Around a third? The Chinese's rate of diabetes is higher. So you are saying it is (in part) because the Chinese are more sedentary than Americans? They walk less, watch more TV and play more video games or computer than Americans, and drive everywhere? I dunno. It's possible.
Sure, Activity level can play a part in T2D. I don't know if being inactive plays a large part in this situation.
I'm afraid I don't know what you are refering to with Eades and Aboriginals. The Aboriginals ate a traditional diet and were more sedentary and that helped reverse their T2D?0 -
lemurcat12 wrote: »T2D increases with the obesity rate of a society. Sure, some people are outliers (or take drugs or engage in other behaviors that may be independently risk factors -- high soda consumption may be), but the T2D rate in traditional societies with low diabetes rates is quite low to non-existent, even with higher carb consumption (the diet as a whole is typically quite different than the average US diet, but not so much carb %). Also, people are much more active.
I think a large part of it is the types of carbs eaten. It appears societies that start eating grains and sugars tend to have higher rates of T2D than those that eat carbs made up of veggies and some fruits.
For example, China typically has a higher carb diet. That seemed to work well for them in the past when foods were more traditional, but now that theri diet is more westernized (more wheat and sugar than before being likely culprits) their rate of T2D is quite high. I think they are at 11%. That's higher than the USA.
It doesn't seem to be grains or starches. Such societies often include decent amounts of them without T2D or other modern diseases. (One reason I think paleo is wrong, as well as the fact they were part of the human diet even during the paleo period.) China has traditionally had a high rice consumption, as has Japan -- their protein consumption has likely increased more than grain. Overall I think it's a more modern or wealthier diet, which is hard to separate from other factors, such as less activity, higher amounts of sat fat, and just more calories in general. I personally do suspect there's a contribution from all of the above, including more high cal, low nutrient, low fiber foods, like many high sugar processed products (vs. fruit), as well as less fruits and veg as part of the overall diet, but I don't think it's easy to sort out and I am not sure that that's more than my own prejudice. There are some articles I've read that the in some ways horrible British diet during WW2 and rationing was actually positive for health, because of limited ability to have some of the more luxurious foods (both sugar and sat fat), despite more starchy stuff (like potatoes, which were encouraged), and lots of awful-sounding processed stuff (again, contra the idea that "processed" always means the same thing). I will not be at all surprised if there are more studies that do show a contribution of food type. As you know, I tend to buy into the Michael Pollan/David Katz articles that are sometimes presented, so that is my bias/interpretation of the evidence.0 -
That could well be. I hope they figure it out in my lifetime. I'd like to know.0
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That could well be. I hope they figure it out in my lifetime. I'd like to know.
There's been a fair amount written on the correlation between sugar-sweetened beverages (SSBs) and metabolic syndrome/T2D.
Here's a recent meta-analysis:
http://m.care.diabetesjournals.org/content/33/11/2477.full.pdf1 -
That could well be. I hope they figure it out in my lifetime. I'd like to know.
There's been a fair amount written on the correlation between sugar-sweetened beverages (SSBs) and metabolic syndrome/T2D.
Here's a recent meta-analysis:
http://m.care.diabetesjournals.org/content/33/11/2477.full.pdf
Interesting. Thanks.
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Here's a Bloomberg opinion piece on Asian countries' push to levy sugar taxes in order to curb consumption of sugar-sweetened beverages.
Not surprisingly, Coca-Cola and other carb-peddling charter members of Big Sugar are not going down without a fight. Following the lead of Big Tobacco decades earlier, BS intends to spend billions building markets in developing Asian countries, as health-conscious western countries reduce their sugar consumption:
http://www.bloombergview.com/articles/2016-02-23/soda-taxes-can-protect-health-in-asia
There's also the depressing yet fascinating international diabetes atlas project:
Http://www.Diabetesatlas.org
From the 2015 executive summary:IDF’s call for action
IDF’s mission is to promote diabetes care, prevention and a cure worldwide and it takes a leading role in influencing policy, increasing public awareness and encouraging improvements in health.
Notably in 2015, the United Nations Member States adopted the Sustainable Development Goals which included targets on non-communicable diseases. The previous Millennium Development Goals had omitted diabetes and other non-communicable diseases which presented an obstacle to establishing
resources and political focus to tackle diabetes.
During the 2015 G7 Summit, IDF launched a call to action for all G7 nations to develop and implement cost-effective policies to improve the health outcomes for people with diabetes and to prevent new cases.
In 2015, IDF published its Framework for Action on Sugar, which recognises the important role that excess sugar consumption has in increasing the risk of type 2 diabetes, and presents a series of policy initiatives aimed at reducing consumption of sugar and increasing production and availability of more healthy foods.
As part of IDF’s work with The European
Connected Health Alliance to create a global network of Diabetes Aware Cities, IDF piloted the Diabetes Prevention Score in 2015. This will enable cities globally to assess how their urban environments can be improved to support prevention of type 2 diabetes in communities.
By continuing to increase awareness of diabetes and promote care and prevention, IDF hopes that today’s estimates for 2040 will be purely hypothetical.0 -
Thanks. Those are indeed depressing yet fascinating links.
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Progression of insulin sensitivity and insulin secretion over 5 years. Orange arrows started with Normal Glucose Tolerance, pale blue with Impaired Glucose Tolerance and darker blue with Diabetes Mellitus. Reported here . If your Acute Insulin Response (y-axis) can respond to a decline in insulin sensitivity (x-axis) you're OK, if not you're progressing towards diabetes.
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Table 3 of this study shows the change in variables over 5 years when following the change in insulin sensitivity (above graph). This does not show a statistically significant difference in the change of either BMI or waist circumference between individuals who had normal glucose tolerance at baseline and either retained it or progressed to impaired glucose tolerance or diabetes. In this case the mean BMI increase was smallest in those progressing from normal glucose tolerance to diabetes.
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Maintaining a healthy body fat% followed by regular cardio and strength training are it for preventing diabetes. Once you HAVE it though, the focus should be on obtaining those two things with a focus on limiting the carbs.0
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"Exercise Training, Without Weight Loss, Increases Insulin Sensitivity" http://care.diabetesjournals.org/content/26/3/557
Exercise increased SI (2.54 ± 2.74 vs. 4.41 ± 3.30 μU · ml−1 · min−1, P < 0.005) in previously sedentary adults. 6 months of walk training (intensity 45–55 or 65–75% heart rate reserve, frequency 3–4 or 5–7 days/week, duration 30 min/session).0 -
Insulin resistance & keto carb targets
Stephen Phinney related this observation from Tim Noakes:The more insulin resistant a person is, the further they have to go down the carbohydrate intake scale to drop down toward the improved metabolic condition and to get out of the damaging zone as a result of carb intake.
It seems obvious once you hear it, but it's another reminder that one size just don't fit us all.1 -
I am type 1 diabetic. I have spent 32 years working on what works best for me. I do think it is person to person. I find that when I am not overweight that a very low processed carb diet works well for me needing very little insulin. I eat natural carbs and don't need a great deal of insulin. Examples are things like fruits (not fruit juice ever) and veggies. If I am not overweight and eat processed crap, I need tons of insulin and it may go on for hours before the blood glucose goes to a normal reading. If I am overweight, I need more insulin for processed or non. I also do not live like the typical diabetic. If I need to lose weight, I eat less food. I intermittent fast and I eat 1000 or under calories. I no longer subscribe to breakfast, lunch and dinner. I eat only when I am hungry and I I am not hungry I do not try to make up calories for the day by eating them. It is a great deal of work to monitor the diabetes and the macros/calories etc, but this is what works for me. I suppose my diet could closest be paleo but I don't necessarily follow that plan. I just like meat,veggies and fruits and it is what works best for me as a diabetic on insulin.2
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I am type 1 diabetic. I have spent 32 years working on what works best for me. I do think it is person to person. I find that when I am not overweight that a very low processed carb diet works well for me needing very little insulin. I eat natural carbs and don't need a great deal of insulin. Examples are things like fruits (not fruit juice ever) and veggies. If I am not overweight and eat processed crap, I need tons of insulin and it may go on for hours before the blood glucose goes to a normal reading. If I am overweight, I need more insulin for processed or non. I also do not live like the typical diabetic. If I need to lose weight, I eat less food. I intermittent fast and I eat 1000 or under calories. I no longer subscribe to breakfast, lunch and dinner. I eat only when I am hungry and I I am not hungry I do not try to make up calories for the day by eating them. It is a great deal of work to monitor the diabetes and the macros/calories etc, but this is what works for me. I suppose my diet could closest be paleo but I don't necessarily follow that plan. I just like meat,veggies and fruits and it is what works best for me as a diabetic on insulin.
And I am very active. I do believe exercise is the key to making me the healthy diabetic I am in addition to the above.0 -
I don't understand how some people can reverse their IR by eating a high carb diet (independent of weight control). Unless it's just simply that some people respond very differently to different diets, which may be why there are conflicting studies on what the optimal diet should be for those with the condition.
http://180degreehealth.com/starch-lowers-insulin/0 -
ForecasterJason wrote: »I don't understand how some people can reverse their IR by eating a high carb diet (independent of weight control). Unless it's just simply that some people respond very differently to different diets, which may be why there are conflicting studies on what the optimal diet should be for those with the condition.
http://180degreehealth.com/starch-lowers-insulin/
It's a mystery to me, too. Stephen Phinney in several of his videos emphasizes that different people do better on different types of diets, and that there are indeed people built for higher carbs. (Pretty sure he's thinking high-nutrient density carbs, not white-flour waffles with corn syrup and powdered sugar and a Coke on the side.)
But when it comes to IR..... well, that's really mysterious.. There are a lot of people following LCHF who swear by consuming small amounts of resistant starch, like potato starch (but not potato flour), on the theory that the wonders it works in your small intestine ultimately lower your IR. But there are others who warn that pulling a single starch off the taboo list is not sufficient, because you need a full range of plant nutrients to get the desired effect....
Confusing enough that I haven't tried it yet.
Anyone?0 -
My patients can and do get off of their diabetes medication if they maintain a low carb diet and exercise long term.1
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